|Year : 2014 | Volume
| Issue : 4 | Page : 136-139
Contribution of corneal blindness to visual disability among street blind beggars in a local government area of a state in Northern Nigeria
Aliyu Hamza Balarabe
Department of Ophthalmology, Federal Medical Centre, Birnin Kebbi, Kebbi State, Nigeria
|Date of Web Publication||11-Dec-2014|
Aliyu Hamza Balarabe
Department of Ophthalmology, Federal Medical Centre, P. M. B. 1126, Birnin Kebbi, Kebbi State
Aim: To determine the contribution of corneal blindness to visual disability among Blind Street Beggars (bsb) with a view to draw the implications to blindness prevention programme in Sokoto North Local government area (LGA) . Materials and Methods: The cross sectional study was conducted in Sokoto North Local LGA in Sokoto State. The study was conducted over a period of six weeks between May and June, 2009. Ethical clearance was obtained from the Ethical Committee of University of Ilorin Teaching Hospital. The list of blind persons in these areas was obtained from the traditional head of the blind (Sarkin Makafi) who assisted in mobilizing the subjects. Blind subjects who consented were included in the study. Data obtained were entered and analyzed in form of frequency tables using Epi-info 2000 statistical software package . Results: A total of 202 of the registered persons were found to be blind on ophthalmic examination and were therefore included in the analysis. There were 107 (53%) males and 95 (47%) females with a mean age of 49 years. One hundred and sixty four (81.2%) blind beggars became blind during childhood period while 38 subjects (18.8%) became blind during adulthood. Trachoma corneal opacity was responsible for 12.8% of the blindness while other corneal opacity accounted for 60.8%. Conclusion: Majority of the subjects had preventable blindness. We recommend a comprehensive eye care programme with a strong emphasis on health education and prompt treatment of these causes as a means of reducing the population of street blind beggars in Sokoto North LGA.
Keywords: Blind beggars, childhood blindness, corneal opacity, health education
|How to cite this article:|
Balarabe AH. Contribution of corneal blindness to visual disability among street blind beggars in a local government area of a state in Northern Nigeria. Sahel Med J 2014;17:136-9
|How to cite this URL:|
Balarabe AH. Contribution of corneal blindness to visual disability among street blind beggars in a local government area of a state in Northern Nigeria. Sahel Med J [serial online] 2014 [cited 2022 Jan 22];17:136-9. Available from: https://www.smjonline.org/text.asp?2014/17/4/136/146818
| Introduction|| |
Blindness remains a major public health, social and economic problem especially in the developing world, where more than three-quarters of the world blind people live.  Poor living conditions, poverty, ignorance and lack of health services all impact negatively on vision in this part of the world. 
Blindness has a considerable negative economic implications , for an individual and the community. These implications range from loss of productivity and income to social dependence requiring rehabilitative and supportive services, which are scarcely available in developing countries like Nigeria. ,,, Hence, some blind individuals have to resort to street begging in order to earn a living. 
The prevalence and causes of blindness vary from one region to another , and is highest in developing countries.  Regional variation underscores the need for decentralization of strategic planning of eye care services in order to achieve the goal of VISION 2020: The Right to Sight.  Worldwide,  cataract still remains the major cause of blindness accounting for 47.8% of blindness and glaucoma recording 12.3%. Age related macular degeneration, now emerging as a major cause of blindness especially in the developed countries accounted for 8.7%.
The major causes of blindness also vary from one region to the other. In the industrially developed countries, the causes are mainly due to degenerative and metabolic diseases. ,
Data obtained during the Nigerian national survey of blindness and low vision,  showed that cataract accounted for 43% of blindness. Others are glaucoma (16%) and corneal opacity (12%).
This study was conceived with the aim of providing data on the causes of blindness among blind street beggars in Sokoto North local government area (LGA) of Sokoto State, Nigeria and the contribution of corneal blindness to visual disability, with a view to highlight its implications on the implementation of blindness prevention program within the study area.
| Materials and methods|| |
The cross-sectional study was conducted in Sokoto North LGA, which constitutes a segment of the Sokoto City metropolitan area and has a population of 226, 397.  The study was carried out over a period of 6 weeks from May to June, 2009. Institutional consent for the study was obtained from the University of Ilorin Teaching Hospital Ethical Committee. Approval for the commencement of field work was obtained from the LGA Authority.
Street beggars'' are individuals or groups, who beg or make a living from the streets by asking people for money, food and clothes as gifts or charity.  The blind street beggars have been noticed to congregate around eight major streets of the LGA. The list of blind persons in these areas was obtained from the traditional head of the blind (Sarkin Makafi) who assisted in mobilizing the subjects. Blind subjects who consented were included in the study.
Data were collected using a semi structured questionnaire, which captured the demographic data including age, sex and educational attainment of the subjects. Information on antecedents and the age at the onset of blindness was obtained. The questionnaire was administered by the author.
The questionnaire was pre-tested on blind subjects begging in a nearby LGA and modifications made as required. Ophthalmic clinical examination was conducted with the aid of a pen torch and a ×2.5 magnifying loupe, snellen E chart and an Ophthalmoscope where appropriate by the author. All causes of blindness in each individual were listed, but the most likely pathology leading to visual loss and the most amenable to treatment was taken as the principal cause of blindness for the subject as per WHO recommendations/rankings. 
The detailed methodology has been accepted for publication by the Middle East Africa Journal of Ophthalmology as the study formed part of a large survey conducted to determine the causes of blindness among beggars in the study area.
Data were subsequently entered into Epi-info 2000 (E12K) (Environmental Systems Research Institute, Inc. (ESRI), Redlands, California, USA). Centers for disease control and prevention. Available online at www.cdc.gov/epo/epi/epiinfo.htm 2000 and analyzed by a statistician using simple frequencies. Categorical variables were compared using Chi-square test. Further analysis was performed using cross tabulations wherever necessary. Level of significance was set at P < 0.05
| Results|| |
A total of 216 (94.7%) subjects were examined out of the 228 subjects that were enumerated. However, 202 subjects were found to be blind after examination and were therefore included in the analysis. The age range was from 8 to 78 years. The mean age was 49 years (standard deviation ± 12.2). Persons aged ranges from 46 and 60 years constituted the highest (44.6%) group. 107 (53.0%) subjects were males while 95 (47.0%) were females.
The age at the onset of blindness is shown in [Table 1]. 164 (81.2%) blind beggars became blind during childhood period and only 38 subjects (18.8%) became blind later as adults. 11 persons (90.9%) of those blind at less than 1 month of age had recurrent eye discharge as an underlying factor.
Non-trachomatous corneal opacity was the major cause of blindness (60.8%), followed by trachomatous corneal opacity (12.8%) and cataract (5.4%). The underlying causes of corneal blindness among persons with non-trachomatous opacity are as shown in [Table 2]. 113 persons (92.9%) out of 123 persons with other corneal opacities were blind from avoidable causes.
|Table 1: Age at the onset of blindness among the blind beggars in Sokoto North LGA |
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|Table 2: Underlying causes of non-trachomatous corneal opacity in Sokoto North LGA |
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| Discussion|| |
Non-trachomatous corneal opacity accounted for about 60.8% of all causes of blindness among blind street beggars. The corneal scarring in this study was most likely due to measles, trauma, infective keratitis as well as ophthalmia neonatorum during the immediate post-natal period. The most common underlying cause of corneal scarring during childhood in the current study was a complication of measles infection which was reported in 46.4% of all persons with other corneal opacities.
The expanded program on immunization (EPI) and administration of vitamin A supplementation during measles epidemics have led to a significant reduction in the number of childhood corneal scarring.  The immunization coverage in Sokoto State has improved from less than 30% in the early 80s to about 75% at present.  This fact was also evident from this study as no case of corneal scarring was found in those below 20 years of age. It is important to mention that a lot has changed in the global pattern of blindness between 1988 and 2008.  There is evidence that burden of blindness in children due to corneal scarring has declined. In Uganda for example 53% of all blind children born between 1951 and 1965 were blind from corneal scarring compared with only 14% for children between 1980 and 1995.  However, some communities such as those living in urban slums and poor communities in rural areas are still affected by vitamin A deficiency and measles today. 
Measles immunization is a large public health intervention that reduces child mortality and morbidity. Since the launch of EPI in 1974, coverage with measles immunization has increased to target levels in most regions of the world.  The number of measles cases and measles related deaths have declined as a consequence. Measles epidemics are now relatively rare and this has led to a decline in measles related corneal blindness.  However many children are still at risk of measles and vitamin A deficiency, particularly in sub-Saharan Africa, where the majority of measles cases and measles related deaths now occur. ,
Trachomatous corneal opacity was responsible for about 12.8% of blindness. It is not surprising as the survey area falls within the trachoma belt in Nigeria. Previous survey conducted within the region has shown that trachoma was a significant health problem in Sokoto State.  On the whole, preventable corneal opacities constituted about 68.6% of all causes of blindness among blind street beggars within the study population.
The introduction of the simplified grading system for trachoma in 1987 and the SAFE strategy (surgery, antibiotics, facial cleanliness and environmental sanitation) in 1996 by WHO represented crucial operational milestones in trachoma control.  The Global Elimination of Trachoma (GETs) strategy and Azithromycin donation by Pfizer together with international trachoma initiative have expanded and accelerated trachoma control activities. Sokoto State joined this initiative by establishing a trachoma control program in 2003 even before the development and take off of Sokoto State eye care program.  This approach when fully implemented and sustained is expected to reduce the burden of blindness from this preventable cause.
Age related Cataract was responsible for only 5.4% of blindness among blind beggars. In a report on a baseline survey of blindness for Sokoto State eye care program, cataract was found to be the most common cause of blindness in the state.  However, cataract is potentially curable and this may account for the low prevalence of cataract in the current report. There are nonetheless, barriers to accessing cataract services as reported from the Nigerian national survey of blindness and low vision.  While the emphasis of blindness prevention program in Nigeria is currently on cataract intervention, our results show the need for strong health education campaign on preventive strategies on prevention of corneal blindness. This may potentially reduce the population of blind street beggars.
| Conclusion|| |
Majority of the subjects had preventable blindness. We recommend a comprehensive eye care program with a strong emphasis on health education and prompt treatment of these causes as a means of reducing the population of street blind beggars in Sokoto North LGA.
| Acknowledgment|| |
We thank the traditional head of the blind in Sokoto state, the LGA and the blind subjects who participated in this study.
| References|| |
VISION 2020: The Right to Sight. Report on World Sight 2002. Executive document. Vol. 1. p. 1-22. Available at www.who.int/ncd/vision2020. [Last accessed on 2010 Oct].
Faal H. National Postgraduate Medical College of Nigeria 8 th
Faculty of Ophthalmology Lecture. Ibadan: The Economics of Sight and Vision Loss; 2005. p. 1-28.
Frick KD, Foster A. The magnitude and cost of global blindness: An increasing problem that can be alleviated. Am J Ophthalmol 2003;135:471-6.
Mahmoud AO, Olatunji FO, Ayanniyi AA. Ophthalmologists' perceptions of the rehabilitation services for the irreversibly blind in Nigeria. Niger J Ophthalmol 2005;13:58-61.
Olatunji FO, Mahmoud AO, Ayanniyi AA. What Nigerian ophthalmologists do for their irreversibly blind patients. Trop J Health Sci 2006;13:36-41.
Kana IA. Magnitude and causes of irreversible blindness and the assessment of needs for rehabilitation services in Chikun Local Government Area of Kaduna State: A Dissertation for the Award of Fellowship Diploma in Ophthalmology, National Postgraduate Medical College; May, 2007.
Dawodu OA, Ejegi FN. The problem of educating blind children in Benin City, Nigeria. Niger J Ophthalmol 2001;9;20-4.
Mahmoud AO. The role of Muslim health workers in combating avoidable blindness in our society. At-Tabib J 2006;1:26-8.
Abdull MM, Sivasubramaniam S, Murthy GV, Gilbert C, Abubakar T, Ezelum C, et al. Causes of blindness and visual impairment in Nigeria: The Nigeria national blindness and visual impairment survey. Invest Ophthalmol Vis Sci 2009;50:4114-20.
Kyari F, Murthy VS, Gudvalletti G, Salvary S, Clare EG, Abdull M, et al. Prevalence of blindness and visual impairment in Nigeria: The National Blindness and visual impairment survey. Invest Ophthalmol Vis Sci 2009;50:2034-9.
World Health Organization. Magnitude and causes of visual impairment. Fact sheet. Revised 2004. No. 282.
Kocur I, Resnikoff S. Visual impairment and blindness in Europe and their prevention. Br J Ophthalmol 2002;86:716-22.
Muñoz B, West SK. Blindness and visual impairment in the Americas and the Caribbean. Br J Ophthalmol 2002;86:498-504.
National Population Commission Office, Abuja, Nigeria. Projected 2005 census based on 1991 census. National population council; 2007.
Namwata BM, Mgabo MR, Dimoso P. Categories of street beggars and factors influencing street begging in central Tanzania. Afr Study Monogr 2012;33:133-43.
Gilbert C, Muhit M. Twenty years of childhood blindness: What have we learnt? Community Eye Health 2008;21:46-7.
Sokoto State Eye Care Programme/Sight Savers International (SSI) Project Document; 2004. p. 1-82.
Foster A, Gilbert C, Johnson G. Changing patterns in global blindness: 1988-2008. Community Eye Health 2008;21:37-9.
Wadell K. Childhood blindness and low vision in Uganda. Community Eye Health J 1998;12:30-1.
Muhammad N, Maishanu NM, Jabo AM, Rabiu MM. Tracing children with blindness and visual impairment using the key informant survey in a district of north-Western Nigeria. Middle East Afr J Ophthalmol 2010;17:330-4.
Mansur R, Muhammad N, Liman IR. Prevalence and magnitude of trachoma in a local government area of Sokoto State, north western Nigeria. Niger J Med 2007;16:348-53.
Kuper H, Solomon AW, Buchan J, Zondervan M, Foster A, Mabey D. A critical review of the SAFE strategy for the prevention of blinding trachoma. Lancet Infect Dis 2003;3:372-81.
Muhammad N, Mansur RM, Dantani AM, Elhassan E, Isiyaku S. Prevalence and causes of blindness and visual impairment in sokoto state, Nigeria: Baseline data for vision 2020: The right to sight eye care programme. Middle East Afr J Ophthalmol 2011;18:123-8.
A Vision for the Future; The Nigerian National Blindness and Low Vision Survey; Preliminary Report Pamphlet. National Programme for the Prevention of Blindness (NPPB). Abuja, Nigeria: Federal Ministry of Health, Abuja, Nigeria, 2008. p. 1-3.
[Table 1], [Table 2]